Only the Respimat® device is also licensed for use in asthma
Adult over 18 years:
Respimat® Inhalation solution, 5 micrograms once daily (two puffs)
Inhalation powder capsule, one capsule once daily (10 micrograms delivered dose)
The MHRA update below would also apply to tiotropium delivered by the Zonda® device.
MHRA Drug Safety Update (February 2015): When using tiotropium delivered via Respimat® or Handihaler® to treat chronic obstructive pulmonary disease (COPD):
take the risk of cardiovascular side effects into account for patients with conditions that may be affected by the anticholinergic action of tiotropium, including:
myocardial infarction in the last 6 months
unstable or life threatening cardiac arrhythmia
cardiac arrhythmia requiring intervention or a change in drug therapy in the past year
hospitalisation for heart failure (NYHA Class III or IV) within the past year
tell these patients to report any worsening of cardiac symptoms after starting tiotropium; patients with these conditions were excluded from clinical trials of tiotropium, including TIOSPIR
review the treatment of all patients already taking tiotropium as part of the comprehensive management plan to ensure that it remains appropriate for them; regularly review treatment of patients at high risk of cardiovascular events
remind patients not to exceed the recommended once daily dose
SeebriBreezehaler® inhalation powder, hard capsule (£27.50 = 30 capsules)
There is a lack of robust published evidence comparing aclidinium to other bronchodilators and a lack of good quality long term data on efficacy for aclidinium. Because of this it is recommended that aclidinium is reserved for patients who cannot tolerate the first line LAMAs.